Abstract
In a population-diverse country like South Africa the speech-language therapist (SLT) and the client do not always represent the same language and culture. Clients are therefore often served in their second or even third language. This brings about various challenges, but also rewards, which can have an impact on the SLT’s experience of what it means to be an SLT providing early communication intervention (ECI) services. ECI refers to therapy provided to children with communication delays or disorders between the ages of 0 and 3 years in collaboration with their families. ECI must be culturally appropriate because it involves the child’s caregiver and natural environment. The study we describe here aims to capture the essence of the lived experiences of SLTs who practise cross-linguistically and cross-culturally (CLAC) in public hospitals and clinics in the Eastern Cape and along with that, aims to develop a deeper, richer understanding of their experiences working in this complex public health context.
The public health sector provides 84% of South African citizens with healthcare services, which means that only 16% are served by the private sector (Pillay, Tiwari, Kathard and Chikte 2020). According to the country’s most recent population group analysis, the South African public consists of 81% black, 8,8% brown, 2,5% Indian and 7,9% white persons (Department of Communication 2019). Regarding the analysis of home language speakers, Zulu is spoken by most individuals nationwide (25,3%), Xhosa by 14,8% and Afrikaans by 12,2%. English is a home language to 8% of individuals (Statistics South Africa 2018). Since the start of the Department of Health’s community service programme in 1998, the demographic profile of local SLTs has not changed significantly, with 94,6% of SLTs still being female and 59,9% of SLTs white and female (Pillay et al. 2020). The remaining 40% of SLTs represent other cultural groups, which indicates progress. Pillay et al. (2020) found that in a population of 58 million people, only 2,643 persons are qualified SLTs.
In many cases local practising SLTs do not have the necessary knowledge and skills to serve culturally and linguistically diverse populations (Mdlalo, Flack and Joubert 2016) and diagnose and treat clients mostly from the therapist’s own linguistic and cultural framework. Within the framework of the therapist’s background, biases and Western training model, a diagnosis and treatment plan for a client who is a native speaker of a language other than Afrikaans or English is often determined by assessment materials and developmental or behavioural norms that are not culturally and/or linguistically appropriate (Pascoe and Norman 2011).
An important aspect of ECI is that it requires cultural relevance and cultural competence, since the child’s natural environment and caregivers play a major role in the intervention process (The South African Speech-Language-Hearing Association 2017). Cultural competence is not a set destination that can be reached by the therapist, but rather is considered a continuous process of professional development (Verdon 2015). Asking SLTs to reflect on their own cultural competence can be challenging, since this is a skill that is constantly developing and because the therapists may not be familiar with the terminology that exists regarding this. For this reason we decided to ask our research participants to tell stories about their interaction with clients from a different language and cultural background in order to understand the SLTs’ experience in the light of their own cultural competence.
Six participants who work in public hospitals and clinics in Gqeberha and Kariega, and with recent experience of CLAC ECI, participated in the research. Narrative interviews were conducted online, transcribed, and analysed according to the phenomenological-hermeneutic method of interpretation inspired by French philosopher Paul Ricoeur’s interpretation theory (1976) and developed by Lindseth and Norberg (2004). The rigour of the research process was underpinned by a collaborative coder, the creation of an audit trail, review by academic peers and "member checking" where participants were asked to verify the reliability of the identified themes.
By using Ricoeur’s design, we aimed to make sense of the participants’ attempt to make sense of the phenomenon (Smith and Osborn 2008) – also called double hermeneutics. We engaged in a dynamic process where we did not “bracket” our own preconceptions or knowledge, but rather reflected on our own prejudices and knowledge of the phenomenon. This was done by entering into dialogue with the participants and other stakeholders, as well as by making decisions about data analyses in order to provide an authentic description of the phenomenon studied. We and the participants worked together to investigate and develop the true meaning of the phenomenon (Lauterbach 2018).
Five main themes were identified, namely: experience of an internal struggle; awareness of own cultural competence; experience leading to knowledge; confrontation with challenges; and strategies to overcome obstacles. The results of the in-depth interpretation of the participants’ experience were as follows: Participants took ownership of their work situation through the daily implementation of strategies; participants were concerned about the effectiveness of their services; participants demonstrated critical self-reflection by thinking critically and acting in the best interest of their clients. An adaptation of Bradshaw’s (2013) framework for culturally responsive early communication intervention is proposed and the clinical implications of this for therapists and training institutions are discussed. We recommend that further research be conducted to investigate the lived experiences of carers and parents who are at the receiving end of CLAC VKI.
Based on existing literature and our empirical findings we formed a preliminary interpretation of the participants’ lived experience, namely: Being an SLT that provides ECI services CLAC in the Eastern Cape brings with it challenges and different emotional experiences, but it also creates opportunities for growth, learning and character development. It requires patience and adaptability and ultimately turns out to be a negative experience for some and a positive one for others. We consider the fruit and the core of the participants’ experiences to be like the poetic description of one participant, who explained the therapy process to a caregiver as follows:
Imagine you are climbing up a mountain and, yes, there’s a lot of work involved. You’re doing the exercises, you’re practising, you are continuing. You’re working, working, working. As you’re working, you’re moving your way up the mountain. But what’s important is when you reach the top of that mountain, the view that you have from there will be unbelievable and worth all the difficult work that you’ve been putting in.
Keywords: cross-linguistic and -cultural; early communication intervention; ECI; lived experience; phenomenology; speech-language therapist; SLT
- The featured image by Shane Rounce with this article was obtained from Unsplash.